Where Have All the Heart Attacks Gone?

We actually expected to see more heart attacks during this time. Respiratory infections typically increase the risk of heart attacks. Studies suggest that recent respiratory infections can double the risk of a heart attack or stroke. The risk seems to begin soon after the respiratory infection develops, so any rise in heart attacks or strokes should be evident by now. We urge people to get flu vaccines every year, in part, to protect their hearts.

Also, times of stress increase the risk of heart attacks and strokes. Depression, anxiety and frustration, feelings that the pandemic might exacerbate, are all associated with a doubling or more of heart attack risks. Work and life stress, which also may be higher with the acute disruptions we’ve all been going through, can markedly increase the risk of a heart attack. Moreover, events like earthquakes or terrorist attacks or war, in which an entire society is exposed to a stressor, are risk factors for heart attacks. Finally, Covid-19 can actually affect the heart, which should be increasing the number of patients with heart problems.

Experts are bringing together data to confirm these patterns. We hope to gain a greater understanding of their causes and consequences.

Meanwhile, the immediate message to patients is clear: Don’t delay needed treatment. If fear of the pandemic leads people to delay or avoid care, then the death rate will extend far beyond those directly infected by the virus. Time to treatment dictates the outcomes for people with heart attacks and strokes. These deaths may not be labeled Covid-19 deaths, but surely, they are collateral damage.

The public needs to know that hospitals are equipped not only to care for people with Covid-19 but also those who have other life-threatening health problems. Yes, we in health care are working to keep people out of the hospital if we can, but we can safely provide care for those people who are not sick from Covid-19. Masks and protective gear for health care workers and patients go a long way to ensure a safe environment. Also, people with chronic conditions need to know that avoidance of needed care could ultimately be as big a threat as the virus itself.

As we fight coronavirus, we need to combat perceptions that everyone else must stay away from the hospital. The pandemic toll will be much worse if it leads people to avoid care for life-threatening, yet treatable, conditions like heart attacks and strokes.

Harlan Krumholz, M.D., is professor of medicine at Yale and director of the Yale New Haven Hospital Center for Outcomes Research and Evaluation.